Improving the assessment of judgment ability in older adults with preclinical and clinical dementia - Project Summary/Abstract
By the year 2050, as many as 16 million persons in the U.S. will express symptoms of Alzheimer’s
disease (AD). The 2015 White House Conference on Aging emphasized the need to improve the detection of
diminished cognitive capacity, maximize independent living, and increase protection of older adults from
financial exploitation and other abuses. Judgment is an important aspect of executive functioning and is critical
to many aspects of real-world functioning among older adults (e.g., financial and medical decision-making
ability). Current methods of assessing judgment, however, lack robust psychometric properties, lack ecological
validity, and are too costly to be routinely administered.
To address these concerns the Test of Practical Judgment (TOP-J) was first published in 2007. Initially
validated on a small, highly-educated Caucasian sample, the TOP-J is an open-ended objective test that has
sound psychometric properties. Further, patient scores on the TOP-J were shown to correlate with cortical
density of two brain regions (i.e., left inferior and superior frontal gyri) known to be associated with judgment.
The TOP-J is increasingly used by neuropsychologists in the United States and internationally. Currently,
further refinement of the initial TOP-J items is being conducted, including development of alternate and
informant forms. To date, there is no standardized measure of judgment available to aging researchers and
clinicians with alternate and informant forms.
In this study, we will: (1) update normative data for the original TOP-J using a diverse sample of older
adults with normal cognition, subjective cognitive decline, mild cognitive impairment (early, amnestic, non-
amnestic), and Alzheimer’s disease, (2) develop and validate an alternate form of the TOP-J, and (3) develop
and validate an informant version of the TOP-J. To achieve aim 1, retrospective data will be pooled from
research collected at the Albert Einstein College of Medicine (Einstein), Geisel School of Medicine at
Dartmouth University, and Indiana University School of Medicine. To achieve aim 2, participants in the
longitudinal aging study at Einstein will be administered the original and newly developed TOP-J items in a
randomized order when they present for their annual study visit. To achieve aim 3, participants and their
informants will be assessed at Nassau University Medical Center’s Department of Physical Medicine &
Rehabilitation and University of Nebraska Medical Center Department of Neurological Sciences. The
achievement of our stated aims will result in improved ability to detect and characterize emerging impairments
in judgment in patients whose diagnoses range from subtle cognitive impairment through dementia, to more
easily monitor changes in judgment ability, to assess risk, and to devise interventions for safe and independent
living in older adulthood.
